Paramedic RSI can mend hearts as well as minds

In this retrospective cohort study, Kwok et al investigated survival to discharge status in cases of non-traumatic cardiac arrest where endotracheal intubation (ETI) was attempted by paramedics in a metropolitan emergency medical services (EMS) system in the USA.

The authors retrieved data for all eligible cases between 1 March 2007 and 30 April 2011 from a cardiac arrest database. These cases were then linked to corresponding records from an airway management registry, which are completed by the paramedic responsible for airway management after each resuscitation attempt. Paramedics within this system are authorised to perform ETI during cardiac arrest and to utilise rapid sequence intubation (RSI) using sedation and neuromuscular blockade where required.

A total of 3 284 cases were identified. Cases with a pre-existing endotracheal or tracheostomy tube (n=11), a do-not-attempt-resuscitation order (n=116) or where the airway management approach could not be determined (n=24) were excluded from analysis. The remaining cases were classified as ETI attempted without RSI (n=2 576, 82%), RSI attempted (n=471, 15%), or no ETI attempt (n=86, 3%).